title: Percutaneous closure of a large aortic paravalvular leak using two duct occluder devices.
abstract: A 21-year-old male presented with severe aortic paravalvular leak. He had undergone three cardiac surgeries and also had chronic kidney disease. It was decided for a trans-catheter closure owing to the risks of a fourth surgery and co-morbidity. The device was sized based on angiogram, balloon sizing and two dimensional transesophageal echo. There was significant residual leak after deployment of first device. Hence the defect was re-crossed and two duct occluder devices were positioned across the leak from two arterial access. After confirming position and satisfactory reduction in paravalvular leak, the devices were released in tandem. There was near abolition of leak. The patient is asymptomatic at three months follow up. Larger paravalvular leaks are better addressed with two devices of smaller size rather than a single large device. Technical considerations while deploying multiple devices are discussed.
authors.affiliation: Department of Pediatric Cardiology, Frontier Lifeline Hospital, R-30/C, Ambattur Industrial Estate Road, Mogappair, Chennai 600101, Tamil Nadu, India. Electronic address: drnavni@yahoo.com.
authors.forename: Navaneetha
authors.initials: N
authors.lastname: Sasikumar
authors.forename: Premsekar
authors.initials: P
authors.lastname: Rajasekar
authors.forename: Raghavan
authors.initials: R
authors.lastname: Suramanyan
mesh_terms: D001022:Aortic Valve Insufficiency / Q000601:surgery; D017023:Coronary Angiography; D017548:Echocardiography, Transesophageal; D006345:Heart Septal Defects, Ventricular / Q000601:surgery; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008944:Mitral Valve Insufficiency / Q000453:epidemiology; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000628:therapy*; D019919:Prosthesis Implantation / Q000295:instrumentation* / Q000379:methods; D055989:Septal Occluder Device; D055815:Young Adult